Republicans revamp health bill, boost benefits to older Americans

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By Susan Cornwell and Valerie Volcovici

WASHINGTON, March 19 (Reuters) - U.S. House Republicans are working on changes to their healthcare overhaul bill to provide more generous tax credits for older Americans and to add a work requirement for the Medicaid program for the poor, U.S. House Speaker Paul Ryan said on Sunday.

Ryan said Republican leaders still plan to bring the healthcare bill to a vote on the House of Representatives floor on Thursday. Speaking on the "Fox News Sunday" television program, he added that leaders were working to address concerns that had been raised by rank-and-file Republicans to the legislation.

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Tea Party Patriots supporters hold signs protesting the Affordable Care Act in front of the Supreme Court as the court hears arguments on the health care reform bill on Tuesday, March 27, 2012.

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Affordable Care Act supporters wave signs outside the Supreme Court after the court upheld court's Obamacare on Thursday, June 25, 2015.

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A man holds signs during a protest on the second day of oral arguments for the Patient Protection and Affordable Care Act in front of the U.S. Supreme Court building on March 27, 2012 in Washington, DC. Today is the second of three days the high court has set aside to hear six hours of arguments over the constitutionality President Barack Obama's Patient Protection and Affordable Care Act.

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Sister Caroline attends a rally with other supporters of religious freedom to praise the Supreme Court's decision in the Hobby Lobby, contraception coverage requirement case on June 30, 2014 in Chicago, Illinois. Oklahoma-based Hobby Lobby, which operates a chain of arts-and-craft stores, challenged the provision and the high court ruled 5-4 that requiring family-owned corporations to pay for insurance coverage for contraception under the Affordable Care Act violated a federal law protecting religious freedom.

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An Obamacare supporter counter protests a Tea Party rally in front of the U.S. Supreme Court in the morning hours of March 27, 2012 in Washington, DC. The Supreme Court continued to hear oral arguments on the Patient Protection and Affordable Care Act.

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Affordable Care Act supporters hold up signs outside the Supreme Court as they wait for the court's decision on Obamacare on Thursday, June 25, 2015.

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Ron Kirby holds a sign while marching in protest of the Patient Protection and Affordable Care Act in front of the U.S. Supreme Court on March 26, 2012 in Washington, DC. Today the high court, which has set aside six hours over three days, will hear arguments over the constitutionality President Barack Obama's Patient Protection and Affordable Care Act.

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A protester waves his bible in the air as he overpowered by cheers from supporters of the Affordable Care Act as they celebrate the opinion for health care outside of the Supreme Court in Washington,Thursday June 25, 2015. The Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama's health care overhaul, in a ruling that preserves health insurance for millions of Americans.

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Nuns, who are opposed to the Affordable Care Act's contraception mandate, and other supporters rally outside of the Supreme Court in Washington, D.C., U.S., on Wednesday, March 23, 2016. On Wednesday morning, the Supreme Court is scheduled to hear oral arguments in Zubik v. Burwell, a consolidated case brought by religious groups challenging a process for opting out of the Affordable Care Act's contraception mandate.

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Supporters of contraception rally before Zubik v. Burwell, an appeal brought by Christian groups demanding full exemption from the requirement to provide insurance covering contraception under the Affordable Care Act, is heard by the U.S. Supreme Court in Washington March 23, 2016.

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Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court heard a second challenge to US President Barack Obama's Affordable Care Act. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June.

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 Linda Door (L) protests against President Obama's health care plan in front of the U.S. Supreme Court Building on March 26, 2012 in Washington, DC. Today the high court, which has set aside six hours over three days, will hear arguments over the constitutionality President Barack Obama's Patient Protection and Affordable Care Act.

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Supporters of the Affordable Care Act celebrate after the Supreme Court up held the law in the 6-3 vote at the Supreme Court in Washington June 25, 2015. The U.S. Supreme Court on Thursday upheld the nationwide availability of tax subsidies that are crucial to the implementation of President Barack Obama's signature healthcare law, handing a major victory to the president.

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"We think we should be offering even more assistance than the bill currently does," for lower-income people age 50 to 64, Ryan said of the tax credits for health insurance that are proposed in the legislation.

Ryan also said Republicans are working on changes that would allow federal block grants to states for Medicaid.

Republicans remain deeply divided over their U.S. healthcare overhaul, which is President Donald Trump's first major legislative initiative and aims to fulfill his campaign pledge to repeal and replace Obamacare, the healthcare program of his Democratic predecessor Barack Obama.

Trump has been wooing lawmakers to vote for the bill. He won the backing of a dozen conservative lawmakers on Friday after an Oval Office meeting in which the president endorsed a work requirement and block-grant option for Medicaid.

But there are still holdouts. While Ryan said he felt "very good" about the health bill's prospects in the House, a leading conservative lawmaker, Representative Mark Meadows, told the C-Span "Newsmakers" program that there were currently 40 Republican "no" votes in the House. Republicans hold a majority in the chamber but cannot afford to have more than 21 defections for the measure to pass.

Meadows, a North Carolina Republican, told C-Span's "Newsmakers" the changes being considered for the Medicaid program would not go far enough, if they left it up to states to decide whether to put in place a work requirement.

Even if the healthcare bill were to pass the House, it also would face significant challenges in the Senate.

Senator Tom Cotton, a conservative Arkansas Republican, said that the bill would not reduce premiums for people on the private insurance market. "It's fixable, but it's going to take a lot of work," Cotton said on CNN's "State of the Union."

Moderate Republicans have also expressed concerns about the bill, and their worries are often not the same as that of conservatives.

Speaking on NBC's "Meet the Press," Republican Senator Susan Collins of Maine worried the bill would harm older Americans, and shift Medicaid costs to states -- something critics say a block-grant approach would only make worse.

Collins said coverage issues must also be dealt with, citing a report from the Congressional Budget Office that said 14 million people would lose health coverage under the House bill over the next year and 24 million over the next decade.

Affordability has been one of the bigger concerns that insurers and hospital groups have raised about the legislation. To the extent that a change in tax credits makes healthcare more affordable for some people, insurers and hospitals could stand to benefit.

When the draft of the health care bill was released earlier this month, the BlueCross BlueShield Association, which represents BCBS insurers that cover the vast majority of the about 10 million people enrolled in 2017 Obamacare plans, emphasized the need for the replacement to be affordable.

(Editing by Sandra Maler and Phil Berlowitz)

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